Nursing Elites

1. A client who underwent lobectomy 24 hours ago has not had any chest tube drainage for the past hour. What should the nurse do first?

• A. Contacts the physician
• B. Checks for kinks in the drainage system
• C. Checks the client’s blood pressure and heart rate
• D. Connects a new drainage system to the client’s chest tube

Correct answer: B

Rationale: When a chest tube is not draining, the nurse's initial action should be to check for kinks or clots in the chest drainage system. This step helps to ensure the patency of the system and allows for proper drainage. Checking the client's blood pressure and heart rate is important but not the priority when addressing a lack of chest tube drainage. Contacting the physician is warranted if signs of respiratory distress or mediastinal shift are observed after ruling out kinks or clots. Connecting a new drainage system is done when the fluid chamber is full, following a specific procedure to maintain a closed system and prevent complications.

2. A client is scheduled to have an arteriogram. During the arteriogram, the client reports having nausea, tingling, and dyspnea. The nurse's immediate action should be to:

• A. Administer epinephrine.
• B. Inform the physician.
• C. Administer oxygen.
• D. Inform the client that the procedure is almost over.

Correct answer: B

Rationale: The correct immediate action for the nurse to take in this situation is to inform the physician. The symptoms described - nausea, tingling, and dyspnea - indicate a potential allergic reaction to the contrast dye used in the arteriogram. It is crucial to notify the physician promptly so that further assessment and appropriate interventions can be initiated. Administering epinephrine without physician guidance can be dangerous as the physician needs to evaluate the severity of the reaction and determine the necessary treatment. Administering oxygen may be needed but should be done under the physician's direction. Informing the client that the procedure is almost over is not a priority when the client is experiencing symptoms of a possible allergic reaction.

3. The healthcare provider assesses a client with cirrhosis and finds 4+ pitting edema of the feet and legs, and massive ascites. Which mechanism contributes to edema and ascites in clients with cirrhosis?

• A. Hyperaldosteronism causing increased sodium transport ion in renal tubules
• B. Decreased portacaval pressure with greater collateral circulation
• C. Decreased renin-angiotensin response related to increased renal blood flow
• D. Hypoalbuminemia that results in decreased colloidal oncotic pressure

Correct answer: D

Rationale: In clients with cirrhosis, hypoalbuminemia leads to decreased colloidal oncotic pressure. This reduction in oncotic pressure contributes to the development of edema in the feet and legs (pitting edema) and ascites in the abdomen. Hyperaldosteronism (choice A) would lead to sodium retention but is not the primary mechanism behind edema and ascites in cirrhosis. Decreased portacaval pressure with greater collateral circulation (choice B) is not directly related to the pathophysiology of edema and ascites in cirrhosis. Decreased renin-angiotensin response related to increased renal blood flow (choice C) does not play a significant role in the development of edema and ascites in cirrhosis compared to the impact of hypoalbuminemia on colloidal oncotic pressure.

4. When conducting discharge teaching for a client diagnosed with diverticulitis, which diet instruction should the nurse include?

• A. Have small, frequent meals and sit up for at least two hours after meals
• B. Eat a bland diet and avoid spicy foods
• C. Eat a high-fiber diet and increase fluid intake
• D. Eat a soft diet with increased intake of milk and milk products

Correct answer: C

Rationale: For a client diagnosed with diverticulitis, the nurse should instruct them to eat a high-fiber diet and increase fluid intake. This diet helps in managing diverticulitis by promoting bowel regularity and preventing complications such as diverticular inflammation or infection. Choice A of having small, frequent meals and sitting up for at least two hours after meals may be beneficial for gastroesophageal reflux disease but is not specific to diverticulitis. Choice B of eating a bland diet and avoiding spicy foods is not the preferred recommendation for diverticulitis management. Choice D of eating a soft diet with increased intake of milk and milk products may not provide enough fiber to aid in diverticulitis management, and the increased intake of dairy products may worsen symptoms in some individuals.

5. Which of the following is a key symptom of hypothyroidism?

• A. Weight loss.
• B. Heat intolerance.
• C. Cold intolerance.
• D. Increased appetite.

Correct answer: C

Rationale: Cold intolerance is a key symptom of hypothyroidism because a decreased metabolic rate leads to a reduced ability to regulate body temperature. Weight loss (Choice A) is more commonly associated with hyperthyroidism, where the metabolic rate is increased. Heat intolerance (Choice B) is also more indicative of hyperthyroidism, where excess thyroid hormone leads to an increased sensitivity to heat. Increased appetite (Choice D) is not typically seen in hypothyroidism; instead, individuals with hypothyroidism may experience weight gain due to the slowed metabolism.

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